Provider Demographics
NPI:1003087669
Name:NUVISION
Entity Type:Organization
Organization Name:NUVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNTA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-952-0070
Mailing Address - Street 1:134 DYESS RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4410
Mailing Address - Country:US
Mailing Address - Phone:601-952-0070
Mailing Address - Fax:601-952-0076
Practice Address - Street 1:134 DYESS RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4410
Practice Address - Country:US
Practice Address - Phone:601-952-0070
Practice Address - Fax:601-952-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04923053Medicaid